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The Foreign Nurse Dilemma

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by Armand L. Circharo, Jr

For many years now, people closely connected with the healthcare community in the United States have been aware of one of lurking issue: the shortage of registered nurses in the healthcare workforce. While initially this knowledge was almost exclusively restricted to the industry insiders, the past few years have seen the topic picked up by the mass media and broadcast to the population-at-large. Almost everyone now recognizes that there is a shortage of registered nurses in US hospitals and healthcare facilities. However what many still do not recognize is that the shortage is growing and that very few if anyone actually understand either the root cause of the shortage or what steps should be taken to alleviate the problem.

Needless to say, many over-populated and under-staffed hospitals have neither the resources nor the inclination to solve the national dilemma; they have an immediate need for staff and are busy trying to resolve their own shortage issues. However, many hospital CEOs will readily admit that finding and retaining quality nurses is their single greatest challenge with vacant nursing positions accounting for over 75% off all unfilled hospital positions.

Unfortunately, there isn’t one answer to this problem, but rather it will more likely be solved by disparate and coordinated efforts from government and private sector alike. Some of the more commonly discussed solutions are:

• Encouraging And Facilitating The Processes Of Bringing New Students Into The Nursing Profession: As professional and educational opportunities – particularly for women – have improved in recent years, many students have overlooked nursing in favor of more highly paid professions. Low or no-interest loans or even education costs paid for in exchange for long-term employment obligations should help more young adults consider nursing as their career.
• Increase the Population of Males in Nursing: “Meet the Parents” Greg Fokker notwithstanding, many males see nursing as the exclusive purview of females. Indeed, for most of its’ history nursing has been – and continues to be – dominated by females. For much of the 20th century, many if not most female high school graduates were pointed into vocations such as teaching, secretarial and, of course, nursing. However the profession has changed dramatically in the last few years; nursing has become even more demanding than ever, requiring long hours and coordinating heavy patient caseloads. Additionally the salary and hourly rates within nursing have increased dramatically during the shortage as have the benefits. These considerations should be helpful in attracting more males into the profession.
• Increased Foreign Recruitment of Nurses: While this seems like an obvious solution, it has also been plagued with problems, both ethical and logistical. Some industry insiders consider the use of foreign nurses parochial and self-serving and cite the detrimental impact of siphoning foreign nurses on the quality of care in their home countries. Admittedly it is not a panacea for the shortage in the US but rather one part of a multi-part solution. Furthermore, if enacted with care and concern for the countries from which the nurses are recruited, it can be an effective, long-term mitigating factor in ameliorating the crisis here at home. However before this can be successfully utilized, there are bureaucratic as well as cultural issues that need to be addressed.

By all indications the total population of foreign nurses in the US is somewhere in the vicinity of 13% - 15% of the total RN workforce. Not a very large portion when one considers that US healthcare institutions have been bringing foreign nurses into the country for approximately 50 years. However, considering the current vacancy rate and the scarcity of supply within the profession, any position left unfilled – for any reason, including a lack of foreign trained nurses – will most likely either remain unfilled or will be filled by a candidate that leaves an opening somewhere else within the system. Within the US many hospitals are playing out this process of musical chairs as the pace of new nurses coming into the system is offset by both older nurses leaving the profession – or cutting back their hours – and increases in demand created by an ever-aging population.

This is one of the primary benefits of foreign trained nurses; they bring new, incremental supply into the system and therefore allow for filling vacancies without creating newer vacancies elsewhere. Even just in the last year and a half the impact of the loss of international nurses as a source of new nurses has been felt by healthcare providers and staffing agencies nationwide. Consider how many hospitals and healthcare facilities have been utilizing foreign trained nurses either on their own or through agencies to help maintain staffing levels. Now, remove those nurses from the equation and the net impact is clear: these same openings have to be filled through the use of domestic nurses only, creating even more demand from an already taxed population.

Currently the United States immigration program is in retrogression, meaning the US has simply run out of visas for new immigrant workers. This is a condition that has been in various states of severity since November of 2006 without any long-term action or resolution by the United States Congress. As a result it has been impossible to bring new foreign-trained nurses in the country for employment in US hospitals and healthcare facilities. There are currently a number of resolutions and bills on the floors of both houses of Congress. However, Congress has been slow to enact any legislature benefiting the healthcare industry since immigration has become both highly publicized and political. Congress should be encouraged to overlook any politicization of this issue and pass any one of the many bills specific to healthcare immigration as soon as possible.